Some aspects of differential diagnosis of pain syndromes in discogenic neurocompression pathology
Background. A lot of factors may cause development of failed back surgery syndrome after disc hernia (DH) excision. One of them is non-adequate preoperative choice with over-diagnosis or over-estimation of clinical value of discogenic neurocompression pathology (DNP). Neurosurgical intervention is poor effective or in-effective if combined with prevailing non-vertebral disorder or the DH is a mask of another pathology, concomitant silent MRI finding. The purpose of the study was to improve preoperative choice of DH patients due to improvement of differential diagnosis of discogenic neurocompression and other pathologies associated with cervicobrachial or low back or pelvic pain or pain syndrome in extremities. Materials and methods. According to data of the Background. A lot of factors may cause development of failed back surgery syndrome after disc hernia (DH) excision. One of them is non-adequate preoperative choice with over-diagnosis or over-estimation of clinical value of discogenic neurocompression pathology (DNP). Neurosurgical intervention is poor effective or in-effective if combined with prevailing non-vertebral disorder or the DH is a mask of another pathology, concomitant silent MRI finding. The purpose of the study was to improve preoperative choice of DH patients due to improvement of differential diagnosis of discogenic neurocompression and other pathologies associated with cervicobrachial or low back or pelvic pain or pain syndrome in extremities. Materials and methods. According to data of the Clinic of Minimally Invasive and Laser Spinal Neurosurgery of SI “Romodanov Neurosurgery Institute of NAMS of Ukraine” (2013–2015) just 35.3 % of DH patients consulted for persistent pain syndrome had DNP and required surgical intervention. The rest patients (674.7 %) did not undergo DH excision as other disorders caused pain. In this group of patients (4437) with clinically not significant DH the reasons for pain syndrome were assessed. Results. More than half patients were found to have musculo-tonic and myoscleromy syndromes (vertebrogenic reflector (secondary) and primary cervicobrachial or low back or pelvic enthesopathy and in extremities) causing pain and in 17 % patients pathology of extra-vertebral joints and nervous system inflammatory disorders (NSID). The authors represents the criteria for differential diagnosis of pain syndromes in DH and NSID. The etiologic factors of NSID were estimated by complex laboratory data. A clinical case of NSID in DH patient and algorithm for preoperative choice are considered. Conclusions. Diagnosis of DH as a reason for neurologic syndrome is verifying if clinical and neuroimaging data fall together. The identified disruption of neurologic manifestation and MRI data requires thorough examination to distinguish DH patients requiring surgical intervention and patients with silent DH concomitant to other disorders or prevailing non-vertebrogenic disease in a case of combined pathology.
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Omar RO. Bolevyie koreshkovyie sindromy na smezhnyih urovnyah u bolnyih, ranee operirovannyih po povodu degenerativno-distroficheskih zabolevaniy poyasnichno-kresttsovogo otdela pozvonochnika (klinika, diagnostika, lechenie) [Pain radicular syndromes on adjacent levels in patients after interventions for lumbosacral degenerative-dystrophic disorders]. Saint-Petersburg; 2006. 24 p. (In Russian).
Cheremkin SN. Otdalennyie rezultatyi hirurgicheskogo lecheniya kompressionnyih form osteohondroza poyasnichno-kresttsovogo otdela pozvonochnika [Late results of surgical treatment of lumbosacral compression osteochondrosis]. Saint-Petersburg; 2008. 23 p. (In Russian).
Sharma MK, Chichanovskaia LV, Shlemski VA. A comprehensive study of early outcome (at the time of discharge from the hospital) after lumber discectomy for degenerative spine disease. NN Burdenko Journal of Neurosurgery. 2013;77(2):30-4.
Assaker R, Zairi F. Failed back surgery syndrome: to re-operate or not to re-operate? A retrospective review of patient selection and failures. Neurochirurgie. 2015 Mar;61 Suppl 1: S 77-82. doi: 10.1016/j.neuchi.2014.10.108.
Braverman DL, Slipman CW, Lenrow DA. Using gabapentin to treat failed back surgery syndrome caused by epidural fibrosis: A report of 2 cases. Archives of physical medicine and rehabilitation. 2001 May;82(5):691-3. doi: 10.1053/apmr.2001.21867.
Rigoard P, Blond S, David R, Mertens P. Pathophysiological characterisation of back pain generators in failed back surgery syndrome (part B). Neurochirurgie. 2015;61 Suppl 1:S35-44. doi: 10.1016/j.neuchi.2014.10.104.
Schaller B. Failed back surgery syndrome: the role of symptomatic segmental single-level instability after lumbar microdiscectomy. European Spine Journal, 2004;13(3):193-8. doi: 10.1007/s00586-003-0632-x.
Kaurova TA. Algoritmizatsiya lechebno-diagnosticheskogo protsessa pri degenerativno-distroficheskih zabolevaniyah pozvonochnika [Algorithmization of treatment and diagnosis in vertebral degenerative-dystrophic disorders]. Saint-Petersburg; 2012. 154 p. (In Russian). Available from: http://dissland.com/catalog/algoritmizatsiya_lechebno_diagnosticheskogo_protsessa_pri_degenerativno_distroficheskih__avtoreferat.html .
Akhmadov TZ. (2015). Asimptomnyie gryizhi mezhpozvonkovyih diskov [Asymptomatic hernias on intervertebral discs]. In: Proceedings of research and training conference with international participation “Ilizarovskie chteniya”. Rossiya, Kurgan, 10–11 June 2015. pp. 55. (In Russian).
Kogan OG, Shmidt IR, Zaslavskiy ES. Klassifikatsiya nevrologicheskih proyavleniy osteohondroza pozvonochnika i printsipy formulirovaniya diagnoza: metod. rekomendatsii dlya vrachey-kursantov [Classification of neurologic manifestations of vertebral osteochondrosis and principles of diagnosis formulation: guidelines]. Novokuznetsk; 1981. 74 p. (In Russian).
Popelyanskiy YaYu. Ortopedicheskaya nevrologiya (Vertebronevrologiya): rukovodstvo dlya vrachey [Orthopedic neurology (vertebroneurology): guidelines for physicians]. 3 version, revised. Moscow: MEDpress-inform; 2003. 670 p. (In Russian).
Prodan AI, Radchenko A, Korzh NA. (2007). Degenerativnyie zabolevaniya pozvonochnika [Vertebral degenerative disorders]. Vol. 1, Semiotika. Klassifikatsiya. Diagnostika [Semiotics. Classification. Diagnosis]. Kharkiv: Kontrast; 2007. 272 p. (In Russian).
Shtok VN, Levin OS, editors. Spravochnik po formulirovaniyu klinicheskogo diagnoza bolezney nervnoy sistemyi [Guidelines on formulation of clinical diagnosis of nervous system disorders]. Moscow: OOO “Meditsinskoe informatsionnoe agentstvo”; 2006. 520 p. (In Russian). Available from: http://www.studfiles.ru/preview/1574493/
Helimskiy AM. Hronicheskie diskogennyie bolevyie sindromy sheynogo i poyasnichnogo osteohondroza [Chronic discogenic pain syndromes in cervical and low back osteochondrosis]. Habarovsk: RIOTIP; 2000. 256 p. (In Russian).
Zhulev NM. Nevropatii: rukovodstvo dlya vrachey. Saint Petersburg [Neupathies: guidelines for physicans]. Izdatelskiy dom MAPO; 2005. 416 p. (In Russian).
Levin OS. Polineyropatii. Klinicheskoe rukovodstvo [Polyneuropathies. Clinical guidelines]. Moscow: MedInform. Agentstvo; 2005. 496 p. (In Russian).
Maltsev DV, Evtushenko SK. Current approaches to the diagnosis of herpesvirus neuroinfections (scientific review). Mezhdunarodnyi Nevrologicheskii Zhurnal. 2016;3:32-45. doi: 10.22141/2224-07188.8.131.526.77618.
Lutsik AA. Kompressionnyie sindromyi osteohondroza sheynogo otdela pozvonochnika [Compression syndromes in cervical osteochondrosis]. Novosibirsk: Izdatel; 1997. 310 p. ( In Russian).
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